An amount of R160 must be deposited / made out to:
SAPIK – Account number: 9305430937, Branch Code: 632005, ABSA, Tom Street, Potchefstroom.
Reference: Name, surname, RK3.
A copy of the deposit slip must accompany the completed form and be e-mailed to sapikinfo@gmail.com or hand delivered to the office.

The following registration form must be completed in full. Take note that SAQA require specific
information each year. In order to obtain that information, you need to complete all sections of this
form. If this document is incomplete, your registration will not be successful and a fine will be
applicable after March of each year

* Fields are mandatory

* PERSONAL INFORMATION

Last name

Initial

Title

First name

Middle name

Maiden name

ID/Passport number

Nationality

Home language

Ethnic group

Gender

* Physical address

* Postal address

*

Province

Email address

* Cellphone numbers

* Do you have any disability (If yes, elaborate)?

* Rate yourself according to the following: Indicate the correct number next to each question. 1. No difficulty; 2. Some difficulty; 3. A lot of difficulty; 4. Cannot do at all; 5. Cannot be determined, 6. May be part of multiple difficulties, 7. May have difficulty, 8. Former difficulty - none now. For example. Seeing = 2

Seeing:

Hearing:

Communicating:

Walking:

Remembering:

Self-care:

* OCCUPATIONAL INFORMATION

Kinderkineticist in Training

Assistant Kinderkineticist in Training

*

Institution of Training

Year of Training

Program leader (Name and surname)

DECLARATION:
I, hereby apply to be registered as Kinderkineticist in Training / Assistant Kinderkineticist in Training at SAPIK and declare that all information provided (including copies) is completed and correct. I also declare that I have read and understand the updated Ethical Guidelines of SAPIK, and that I agree to abide by these rules and regulations. I accept responsibility to keep updated with any changes made regarding the guidelines.